Healthcare Provider Details

I. General information

NPI: 1437950524
Provider Name (Legal Business Name): LILIAN AGBONZEBETA AZENABOR PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WINNBROOK ST
STAUNTON VA
24401-9204
US

IV. Provider business mailing address

207 WINNBROOK ST
STAUNTON VA
24401-9204
US

V. Phone/Fax

Practice location:
  • Phone: 540-255-9729
  • Fax: 434-404-4746
Mailing address:
  • Phone: 540-255-9729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024191400
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: